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Background/Aim: The aim of this study was to evaluate the cancer detection rate (CDR) using magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided transperineal targeted biopsy (TB). Patients and Methods: We included 401 consecutive patients, of which 161 were biopsy-naïve. All underwent prebiopsy bi-parametric MRI; patients with positive MRI [prostate imaging reporting and data system (PI-RADS≥3)] underwent TB. Biopsy-naïve patients with positive MRI underwent TB and systematic biopsies (SBs). MRI-negative patients underwent SBs. Clinically significant prostate cancer (csPCa) was defined as ISUP ≥2. The added value of SB was defined as an upgrade from a negative biopsy or ISUP of 1 in TB to csPCa in SB. Results: The median (interquartile range) age was 69 (range=63-74) years, and PSA was 6.9 (range=4.5-11) ng/ml. The overall CDR was 65%, with csPCa occurring in 48%. In cases of PI-RADS 5, CDR was 91%, and csPCa was 77%. The added value of SB was 2%. Conclusion: Transperineal TB biopsies using MRI-TRUS fusion yield a high CDR.Multiparametric magnetic resonance imaging (mpMRI) may detect and localize clinically significant (cs) prostate cancer (PCa) with high precision (1, 2). Targeted transrectal biopsies using different navigation systems yield high cancer detection rates (CDRs) but are associated with significant infections (3-5). It is well known that transperineal prostate biopsies cause significantly fewer infections (6-8), but few studies have evaluated the performance of transperineal targeted biopsies (TBs) using image fusion. The aim of this study was to evaluate the CDR using MRI-transrectal ultrasound (TRUS) fusion-guided transperineal TB. Patients and MethodsPatients and inclusion. A total of 550 patients were prospectively included in a two-center randomized control study on the role of antibiotic prophylaxis when using transperineal TB with MRI-TRUS fusion. The results reported in this paper are based on 401 consecutive patients from Oslo University Hospital (OUH). The inclusion period was from November 2019 to March 2021. The study was approved by the Regional Committees for Medical and Health Research Ethics (2019/1266) and has been registered at ClinicalTrials.gov (NCT04146142). Written informed consent was obtained from all patients prior to inclusion. Biopsies were performed at the Department of Urology, OUH.Inclusion criteria included: Elevated PSA or PSA density >0.15 ng/ml 2 , pathological digital rectal exploration (DRE), patients under active surveillance (AS) scheduled for routine re-biopsy, suspicion of recurrence after external beam radiation treatment (EBRT), routine biopsy at one year after partial prostate ablation using high-intensity focused ultrasound (HIFU). Exclusion criteria included: A high risk of post-biopsy infection and an allergy to the study drug. Endpoints included: CDR of anyPCa and csPCa at TB, maximum cancer core length (MCCL), and added value of SB.MRI. Pre-biopsy MRI of the prostate was performed in all patients. At OUS, we used a 1.5T AvantoFit...